GLOBAL DETECTIVE AGENCY, INC.

4971 Avenue D

St Augustine, Florida 32095

Phone (904)739-7929

globaldetectiveagencyinc.com

AUTHORIZATION FOR RELEASE OF

INFORMATION AND PAYMENTS

To: Child Support Enforcement Agency

      State of: __________ County of: ___________

      Attn: County Case Worker: ______________

I,_____________________ Social Security # __________________,

Do authorize and request the Office of the Attorney General, County Child Support Enforcement Agency, State Disbursement Agency or court official to disclose information or records in its possession or control that would be disclosed to me under applicable laws or rules and change my mailing address and forward any payments received by you to the person identified below,

GLOBAL DETECTIVE AGENCY, INC.

4971 Avenue D

St Augustine, Florida 32095

Phone (904)739-7929

On my case with you:

Case # _________________

Name of Non-Custodial Parent ____________________________

Social Security # of Non-Custodial Parent ___________________

I understand that this authorization will automatically expire if the case is closed and I may choose to revoke this authorization at any time by submitting a Revocation of Authorization letter to you.

I certify that there is no court order in effect that prohibits the release of information, and that this information will only be used for child support purposes.

_______________________________            ______________

                    Signature                                             Date

THIS FORM MUST BE NOTORIZED

State of______________

County of ____________

Sworn To and Subscribed Before Me This ______ Day of ____________, 20 _____.

(Seal)                                                              Notary Signature ________________